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Medical Top Patient Care Executive

Directs, through managers, supervisors or head nurses, activities of nursing staff. Administers nursing program in hospital or other medical institution to maintaining standards of patient care. This is the highest level position in patient care.: Plans and organizes activities in nursing services, such as obstetrics, pediatrics, or surgery, or for two or more patient-care units to ensure patient needs are met in accordance with instructions of physician and hospital administrative procedures. Coordinates activities with other patient care units. Advises medical staff, department heads, and hospital administrator in matters related to nursing services. Recommends establishment or revision of policies, and develops organizational structure and standards of performance. Interprets policies and objectives of hospital nursing services to staff and community groups. Performs personnel management functions. Plans and organizes orientation and in-service training for unit staff members, and participates in guidance and educational programs. Assists in formulating budget. Engages in studies and investigations related to improving nursing care. May direct activities of school of nursing.

Patient Transporter

Escorts or transports patients within hospital or other medical facility. Determines patient name, destination, mode of travel, time, and other data, following written or verbal instructions. Directs or escorts incoming patients from admitting office or reception desk to designated area. Carries patient's luggage.: Assists patient in walking to prevent accidents by falling, or transports nonambulatory patient, using wheelchair. Transports patient, alone or with assistance, in bed, wheeled cart, or wheelchair to designated areas within facility during patient stay. Delivers messages, mail, medical records, and other items.

Patient Safety Sitter

Observes patients under the direct supervision of a Registered Nurse to maintain the safety of the patient. Monitors assigned patients within a hospital, skilled nursing, or mental health facility. Typically requires a high school diploma or GED and the ability to read and write fluently in English for documentation purposes. Does not require State licensure. May require completion of behavioral health orientation and crisis prevention intervention training or prior experience with geriatric, developmentally disabled, or mentally ill patients.: Contributes to the maintenance of a safe and therapeutic milieu by promptly reporting safety concerns and pertinent observations to the Registered Nurse on duty. Duties may include preparing meal trays, providing fluids, and walking with patients. Must be capable of transferring and lifting patients as well as ambulating patients to the bathroom.

Medical Patient Relations Representative

Serves as liaison between the employer, patients, and patients' relatives in resolving patient care problems. Resolves patients' complaints and grievances. : Conveys questions, complaints, problems, and concerns of patients to proper personnel. Describes and interprets patient care procedures, and policies to patients. Prepares reports regarding incidents that may result in legal action if not settled. Trains staff on humanizing patients' care. Establishes rapport with personnel. Takes part in employer's public affairs activities.

Patient Relations Representative

Representative Patient

Patient Accounts Representative

Analyzes, prepares, and follows up on insurance claims to include private insurance, Medicare, or Medicaid. Performs a variety of specialized clerical tasks involved in obtaining patient financial precertification and authorizations for health care services and procedures. Typically requires up to two years of experience in billing or accounting.: Organizes inpatient and outpatient claims for electronic or hard-copy mail and forwards to appropriate third party payers. Reviews claims to make sure that payer-specific billing requirements are met, follows up on billing, determines and applies appropriate adjustments, answers inquiries, and updates accounts as necessary. Provides financial counseling to patients and their families regarding charges for health care services. Determines fees for services provided and implements appropriate collection and refund actions. Assists financially responsible persons in arranging payment schedules. Determines necessity of third party sponsorship and processes patients accordingly. Examines insurance policies and other third party sponsor materials for sources of payment. Maintains records of patient's accounts and corrects, updates, and consolidates records to include the application of proper discounts to patients.

Member Services Representative Medical

Communicates effectively with providers and members of the health plan, answering inquiries about member eligibility, plan benefits, claims status and demographics.: In a senior capacity, provides customer service to plan members, providers and employer groups by answering complex benefit questions, resolving issues and educating callers. Receives inquiries from members via the internet, telephone and in writing regarding covered benefits. Provides assistance in resolving problems such as finding physicians, arranging transportation, ordering identification cards, changing primary care case managers, filing appeals, resolving billing errors and accessing payment. Serves as a resource for all entry level Member Service Representatives and may assist with resolution of issues or handle calls that cannot be resolved by less experienced staff. Maintains records of all contacts and results. Provides claim status, payment amounts and/or denials for processed claims. Assists providers with standard electronic claims submission questions and works with providers to resolve problems in filing electronic claims. Researches and resolves problems, complaints and concerns. Mails out provider directories and new member packets. Assists providers and members in accessing information via the organization’s online services directory. Reports suspected cases of member of provider fraud and abuse. Reports successive claims payment issues or member issues to management for appropriate intervention. Typically has more than three years of experience in customer service. May intercede on the member’s behalf with providers and other parties to resolve member problems.

Medicare Patient Representative

Manages Medicare patient accounts, ensuring complete and accurate billing. Interacts directly with patients on billing related matters. Interviews patients and responsible parties to obtain and record personal, family, and financial data.: Analyzes patients' ability to pay and determines appropriate fees, possibly using a sliding scale. Collaborates with the business office, clinical practice teams, and hospital systems to identify appropriate charges and documentation. Verifies Medicare eligibility and prepares input documents for billing. Ensures patient accounts meet Medicare standards and billing requirements. Informs patients of steps to be taken to eliminate indebtedness and the financial impact of various alternatives. Posts credits and debits to accounts and contacts patients with delinquent accounts to arrange payments. Serves as liaison to Patient Financial Services. Communicates with external government payers and employers. May answer telephones in a centralized call center.

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